Natural Language Processing to Identify Abnormal Breast, Lung, and Cervical Cancer Screening Test Results from Unstructured Reports to Support Timely Follow-up.

Cancer screening and timely follow-up of abnormal results can reduce mortality. One barrier to follow-up is the failure to identify abnormal results. While EHRs have coded results for certain tests, cancer screening results are often stored in free-text reports, which limit capabilities for automated decision support.

The effect of mammography screening regimen on incidence-based breast cancer mortality.

Objectives: Incidence-based mortality quantifies the distribution of cancer deaths and life-years lost, according to age at detection. We investigated the temporal distribution of the disease burden, and the effect of starting and stopping ages and interval between screening mammography examinations, on incidence-based mortality.

Methods: Incidence-based mortality was estimated using an established breast cancer simulation model, adapted and validated to simulate breast cancer incidence, screening performance, and delivery of therapies in Canada.

A Randomized Study Comparing Digital Imaging to Traditional Glass Slide Microscopy for Breast Biopsy and Cancer Diagnosis.

Background: Digital whole slide imaging may be useful for obtaining second opinions and is used in many countries. However, the U.S.

National Performance Benchmarks for Modern Diagnostic Digital Mammography: Update from the Breast Cancer Surveillance Consortium.

Purpose To establish contemporary performance benchmarks for diagnostic digital mammography with use of recent data from the Breast Cancer Surveillance Consortium (BCSC). Materials and Methods Institutional review board approval was obtained for active or passive consenting processes or to obtain a waiver of consent to enroll participants, link data, and perform analyses. Data were obtained from six BCSC registries (418 radiologists, 92 radiology facilities).

Alignment of breast cancer screening guidelines, accountability metrics, and practice patterns.

Objectives: Breast cancer screening guidelines and metrics are inconsistent with each other and may differ from breast screening practice patterns in primary care. This study measured breast cancer screening practice patterns in relation to common evidence-based guidelines and accountability metrics.

Study Design: Cohort study using primary data collected from a regional breast cancer screening research network between 2011 and 2014.

National Performance Benchmarks for Modern Screening Digital Mammography: Update from the Breast Cancer Surveillance Consortium.

Purpose To establish performance benchmarks for modern screening digital mammography and assess performance trends over time in U.S. community practice.

Diagnostic Reproducibility: What Happens When the Same Pathologist Interprets the Same Breast Biopsy Specimen at Two Points in Time?

Background: Surgeons may receive a different diagnosis when a breast biopsy is interpreted by a second pathologist. The extent to which diagnostic agreement by the same pathologist varies at two time points is unknown.

Methods: Pathologists from eight U.

Medical home transformation and breast cancer screening.

Objectives: The patient-centered medical home (PCMH) continues to gain momentum as a primary care delivery system. We evaluated whether medical home transformation of primary care practices is associated with the use of breast cancer screening, a broadly endorsed preventive service.

Study Design: Retrospective cohort study evaluating 12 Brigham and Women's Hospital (BWH)-affiliated primary care clinics in greater Boston, Massachusetts.

Annual Combined Mammography and Tomosynthesis Screening: Is It Really Cost-Effective?

Objective: Examining the comparative effectiveness of adding tomosynthesis to mammography screening in the United States would help key stakeholders, including physicians and policy makers, guide shared decision-making and recommendations for routine breast cancer screening.

Conclusion: More robust data from U.S.

Screening Mammography Use Among Older Women Before and After the 2009 U.S. Preventive Services Task Force Recommendations.

Background: It is uncertain how changes in the U.S. Preventive Services Task Force breast cancer screening recommendations (from annual to biennial mammography screening in women aged 50-74 and grading the evidence as insufficient for screening in women aged 75 and older) have affected mammography use among Medicare beneficiaries.

Challenges With Identifying Indication for Examination in Breast Imaging as a Key Clinical Attribute in Practice, Research, and Policy.

Purpose: To assess indication for examination for four breast imaging modalities and describe the complexity and heterogeneity of data sources and ascertainment methods.

Methods: Indication was evaluated among the Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) breast cancer research centers (PRCs). Indication data were reported overall and separately for four breast imaging modalities: digital mammography (DM), digital breast tomosynthesis (DBT), ultrasound (US), and magnetic resonance imaging (MRI).

Breast cancer screening initiation after turning 40 years of age within the PROSPR consortium.

Purpose: Although United States clinical guidelines differ, the earliest recommended age for average risk breast cancer screening is 40 years. Little is known about factors influencing screening initiation.

Methods: We conducted a cohort study within the National Cancer Institute-funded Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium.

A Cluster Randomized Trial of a Personalized Multi-Condition Risk Assessment in Primary Care.

Introduction: Personal risk for multiple conditions should be assessed in primary care. This study evaluated whether collection of risk factors to generate electronic health record (EHR)-linked health risk appraisal (HRA) for coronary heart disease, diabetes, breast cancer, and colorectal cancer was associated with improved patient-provider communication, risk assessment, and plans for breast cancer screening.

Methods: This pragmatic trial recruited adults with upcoming visits to 11 primary care practices during 2013-2014 (N=3,703).

Tailoring Breast Cancer Screening Intervals by Breast Density and Risk for Women Aged 50 Years or Older: Collaborative Modeling of Screening Outcomes.

Background: Biennial screening is generally recommended for average-risk women aged 50 to 74 years, but tailored screening may provide greater benefits.

Objective: To estimate outcomes for various screening intervals after age 50 years based on breast density and risk for breast cancer.

Design: Collaborative simulation modeling using national incidence, breast density, and screening performance data.

Variation in Mammographic Breast Density Assessments Among Radiologists in Clinical Practice: A Multicenter Observational Study.

Background: About half of the United States has legislation requiring radiology facilities to disclose mammographic breast density information to women, often with language recommending discussion of supplemental screening options for women with dense breasts.

Objective: To examine variation in breast density assessment across radiologists in clinical practice.

Design: Cross-sectional and longitudinal analyses of prospectively collected observational data.

Locoregional treatment of breast cancer in women with and without preoperative magnetic resonance imaging.

Background: Preoperative magnetic resonance imaging (MRI) use has increased among older women diagnosed with breast cancer. MRI detects additional malignancy, but its impact on locoregional surgery and radiation treatment remains unclear.

Methods: We examined the associations of preoperative MRI with initial locoregional treatment type (mastectomy, breast conserving surgery [BCS] with radiation therapy [RT], and BCS without RT) and BCS reoperation rates for Surveillance, Epidemiology, and End Results Medicare women diagnosed with stages 0 to III breast cancer from 2005 to 2009 (n = 55,997).

Cost-effectiveness of spinal manipulative therapy, supervised exercise, and home exercise for older adults with chronic neck pain.

Background Context: Chronic neck pain is a prevalent and disabling condition among older adults. Despite the large burden of neck pain, little is known regarding the cost-effectiveness of commonly used treatments.

Purpose: This study aimed to estimate the cost-effectiveness of home exercise and advice (HEA), spinal manipulative therapy (SMT) plus HEA, and supervised rehabilitative exercise (SRE) plus HEA.

Evaluation of 12 strategies for obtaining second opinions to improve interpretation of breast histopathology: simulation study.

Objective:  To evaluate the potential effect of second opinions on improving the accuracy of diagnostic interpretation of breast histopathology.

Design:  Simulation study.

Setting:  12 different strategies for acquiring independent second opinions.

Inadequate Systems to Support Breast and Cervical Cancer Screening in Primary Care Practice.

Background: Despite substantial resources devoted to cancer screening nationally, the availability of clinical practice-based systems to support screening guidelines is not known.

Objective: To characterize the prevalence and correlates of practice-based systems to support breast and cervical cancer screening, with a focus on the patient-centered medical home (PCMH).

Design: Web and mail survey of primary care providers conducted in 2014.

Breast MRI in the Diagnostic and Preoperative Workup Among Medicare Beneficiaries With Breast Cancer.

Purpose: We compared the frequency and sequence of breast imaging and biopsy use for the diagnostic and preoperative workup of breast cancer according to breast magnetic resonance imaging (MRI) use among older women.

Materials And Methods: Using SEER-Medicare data from 2004 to 2010, we identified women with and without breast MRI as part of their diagnostic and preoperative breast cancer workup and measured the number and sequence of breast imaging and biopsy events per woman.

Results: A total of 10,766 (20%) women had an MRI in the diagnostic/preoperative period, 32,178 (60%) had mammogram and ultrasound, and 10,669 (20%) had mammography alone.

Developing a Registry for Thyroid Incidentalomas: Lessons Learned and the Path Forward.

Background: Incidentalomas are findings on an imaging test done for other reasons, for which there are no matching symptoms in the patient. They are common in the adrenal gland, pancreas, liver, and thyroid, among other sites. Incidentalomas are a problem because we have a limited understanding of their natural history: it is difficult to know how much of a threat they pose to individual patients.

Travel Burden to Breast MRI and Utilization: Are Risk and Sociodemographics Related?

Purpose: Mammography, unlike MRI, is relatively geographically accessible. Additional travel time is often required to access breast MRI. However, the amount of additional travel time and whether it varies on the basis of sociodemographic or breast cancer risk factors is unknown.

Cost Effectiveness of Operative Versus Non-Operative Treatment of Geriatric Type-II Odontoid Fracture.

Study Design: Cost-effectiveness analysis.

Objective: To examine the cost-effectiveness of operative versus non-operative treatment of type-II odontoid fractures in patients older than 64 years old.

Summary Of Background Data: Significant controversy exists regarding the optimum treatment of geriatric patients with type-II odontoid fractures.